Tag: pubmed

Ann Work Expo Health. 2022 Dec 24:wxac085. doi: 10.1093/annweh/wxac085. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to characterize polycyclic aromatic hydrocarbons (PAHs) in the breathing zone and on the skin of wildland firefighters and to assess their contribution to urinary 1-hydroxypyrene (1-HP) over repeated firefighting rotations. We asked if improved skin hygiene or discretionary use of an N95 mask would reduce absorption.

METHODS: In collaboration with wildfire services of two Canadian provinces, Alberta and British Columbia (BC), we recruited wildland firefighters from crews willing to be followed up over successive rotations and to be randomly assigned to normal practice, enhanced skin hygiene (ESH), or ESH plus discretionary use of an N95 mask. We collected spot urine samples at the beginning and end of up to four rotations/firefighter. On designated fire days, as close as possible to the end of rotation, we collected skin wipes from the hands, throat, and chest at the beginning and end of the fire day and, in BC, start of fire-day urine samples. Volunteers carried air monitoring pumps. Participants completed questionnaires at the beginning and end of rotations. Exposure since the start of the fire season was estimated from fire service records. Urinary 1-HP was analyzed by LC-MS-MS. Analysis of 21 PAHs on skin wipes and 27 PAHs from air sampling was done by GC-MS-MS. Statistical analysis used a linear mixed effects model.

RESULTS: Firefighters in Alberta were recruited from five helitack crews and two unit crews, and in BC from two unit crews with 80 firefighters providing data overall. The fire season in BC was very active with five monitored fire days. In Alberta, with more crews, there were only seven fire days. Overall, log 1-HP/creatinine (ng/g) increased significantly from the start (N = 145) to end of rotation (N = 136). Only three PAHs (naphthalene, phenanthrene, and pyrene) were found on >20% of skin wipes. PAHs from 40 air monitoring pumps included 10 PAHs detected on cassette filters (particles) and 5 on sorbent tubes (vapor phase). A principal component extracted from air monitoring data represented respiratory exposure and total PAH from skin wipes summarized skin exposure. Both routes contributed to the end of rotation urinary 1-HP. The ESH intervention was not demonstrated to effect absorption. Allocation of an N95 mask was associated with lower 1-HP when modeling respiratory exposure (β = -0.62, 95% CI -1.15 to -0.10: P = 0.021). End of rotation 1-HP was related to 1-HP at the start of the next rotation (β = 0.25, 95% CI 0.12 to 0.39: P < 0.001).

CONCLUSIONS: Exposures to PAHs during firefighting were significant, with samples exceeding the American Conference of Governmental Industrial Hygienists Biological Exposure Index for 1-HP suggesting a need for control of exposure. PAH exposure accumulated during the rotation and was not fully eliminated during the break between rotations. Both respiratory and skin exposures contributed to 1-HP. While improved skin hygiene may potentially reduce dermal absorption, that was not demonstrated here. In contrast, those allocated to discretionary use of an N95 mask had reduced 1-HP excretion. Wildland firefighters in North America do not use respiratory protection, but the results of this study support more effective interventions to reduce respiratory exposure.

PMID:36565164 | DOI:10.1093/annweh/wxac085

Pharmacol Res Perspect. 2023 Feb;11(1):e01017. doi: 10.1002/prp2.1017.

ABSTRACT

Population-based drug utilization studies are scanty in Nigeria. The aim was to determine the pattern and predictors of medication use among adults in the communities of Southwestern Nigeria. A cross-sectional study was conducted among adults selected by multi-stage sampling from Oyo State communities. The questionnaires, adapted from the WHO Students’ Drug Use Questionnaire and previous studies, were pretested and interviewer administered. The respondents’ socio-demographic characteristics, the pattern of medication use, prescribers, and sources of drug acquisition were obtained. Binary logistic regression was used to determine the predictor of medications used. Of the 999 respondents, 501 resided in rural communities while 498 dwelled in urban areas. The mean (±SD) age of the respondents was 38 ± 15 years. The median (range)% prevalence of medication use were as follows: lifetime use, 58.2 (17.7-81.0); current use, 31.2 (8.9-65.9); and past use, 20.3 (9.2-28.9). Medications were mainly obtained from patent medicine stores, median (range%), 71 (65-80). The commonly used drugs were paracetamol, 626 (67.6); nonsteroidal anti-inflammatory drugs, 174 (18.8); artemether/lumefantrine, 422 (68.2); ampicillin/cloxacillin, 220 (48.6); and chlorpheniramine, 59 (39.9). Factors predictive of current medication use, adjusted odd ratio (95% confidence interval) were as follows: antimalarial [male, 0.7 (0.5, 0.9)]; antibacterial [male, 0.6 (0.4-0.9)]; analgesics [married, 1.5 (1.1-2.2); presence of health facilities, 0.5 (0.3-0.7); and shorter distance to health facility, 1.5 (1.1-2.1)]. Antimalarials, antibacterial, and analgesics were commonly used and inappropriately obtained by adults in Southwestern Nigeria. Factors predictive of current medication use were gender, marital status, the presence of health facilities, and distance to health facilities. There is a need for more extensive countrywide medication use studies and enlightenment programs to ensure the appropriate use of medications.

PMID:36565158 | DOI:10.1002/prp2.1017

Am Surg. 2022 Dec 24:31348221146945. doi: 10.1177/00031348221146945. Online ahead of print.

ABSTRACT

INTRODUCTION: The gender and minority gap in general surgery residency is narrowing; however, literature lacks comprehensive data regarding the demographics of fellowship programs following general surgery training.

METHODS: Data from 2017 to 2021 for gender, ethnicity, and surgical subspecialty are publicly available from the ERAS database and ACGME yearly data reports. Cochran-Armitage trend tests were used to determine statistical significance in trends for female and minority applicants and trainees.

RESULTS: The overall trend of female applicants to surgical specialties remained stagnant. However, female applicants to vascular surgery increased significantly from 25% to 35% (P = .045). There was no significant increase in female trainees in any surgical specialties evaluated. Furthermore, the overall trend of minority applicants to surgical specialties also remained stagnant, except for pediatric surgery, which showed significantly fewer minority applicants. Despite pediatric surgery having fewer applicants, minority trainees in this specialty increased significantly from 8% to 19% (P = .008).

CONCLUSION: Several current initiatives, such as intentional mentorship, are being reported to promote diverse and equal representation among female and minority applicants and trainees. However, the current overall margin of increase in diversity among surgical specialty applicants and trainees is minimal, indicating that continued efforts are needed to diversify surgical specialty training programs.

PMID:36565153 | DOI:10.1177/00031348221146945

J Neuromuscul Dis. 2022 Dec 16. doi: 10.3233/JND-221600. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Disease progression in patients with spinal muscular atrophy (SMA) has changed dramatically within the past years due to the approval of three different disease-modifying treatments. Nusinersen was the first drug to be approved for the treatment of SMA patients. Clinical trials provided data from infants with SMA type 1 and children with SMA type 2, but there is still insufficient evidence and only scarcely reported long-term experience for nusinersen treatment in ambulant patients. Here, we report data from the SMArtCARE registry of ambulant patients under nusinersen treatment with a follow-up period of up to 38 months.

METHODS: SMArtCARE is a disease-specific registry in Germany, Austria and Switzerland. Data are collected as real-world data during routine patient visits. Our analysis included all patients under treatment with nusinersen able to walk independently before start of treatment with focus on changes in motor function.

RESULTS: Data from 231 ambulant patients were included in the analysis. During the observation period, 31 pediatric walkers (27.2%) and 31 adult walkers (26.5%) experienced a clinically meaningful improvement of≥30 m in the 6-Minute-Walk-Test. In contrast, only five adult walkers (7.7%) showed a decline in walking distance≥30 m, and two pediatric walkers (1.8%) lost the ability to walk unassisted under treatment with nusinersen. HFMSE and RULM scores improvemd in pediatric and remaind stable in adult patients.

CONCLUSION: Our data demonstrate a positive effect of nusinersen treatment in most ambulant pediatric and adult SMA patients. We not only observed a stabilization of disease progression or lack of deterioration, but clinically meaningful improvements in walking distance.

PMID:36565133 | DOI:10.3233/JND-221600

Clin Hemorheol Microcirc. 2022 Dec 23. doi: 10.3233/CH-221658. Online ahead of print.

ABSTRACT

OBJECTIVE: assessment of the effect of a series of 20 whole-body cryotherapy sessions on the morphological and rheological indicators of blood in healthy people.

METHODS: The experimental group consisted of 15 women and 15 men who underwent a series of whole-body cryotherapy treatments. The control group consisted of 15 women and 15 men – without intervention. For the analysis of blood biochemical parameters, venous blood was collected twice: Study 1: on the day of the commencement of whole body cryotherapy / from the control group; and Study 2: after a series of 20 cryotherapy sessions / from the control group (4 weeks).

RESULTS: After whole-body cryotherapy a statistically significant decrease in RBC, HGB, HCT, MCV, EI 0.30 and an increase in MCHC and EI 2.19-60.30 were observed in women, as well as a decrease in MCV, MCH, AI and an increase in PLT, EI 0.30-60.30, AMP, T1/2 in men.

CONCLUSIONS: The use of whole-body cryotherapy causes changes in blood counts in various directions and has a positive effect on the rheological properties of blood in women and men – it increases the elongation index and reduces the aggregation index.

PMID:36565109 | DOI:10.3233/CH-221658

Clin Hemorheol Microcirc. 2022 Dec 23. doi: 10.3233/CH-221610. Online ahead of print.

ABSTRACT

BACKGROUND: Venous malformations tend to retain their slow-flow behavior, even in progressive disease or regression following therapy.

OBJECTIVE: The aim of this study is to analyze the development of acquired hemodynamic relevant arterio-venous fistulae in patients with slow-flow malformations.

METHODS: This study is a retrospective analysis based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with venous malformations and development of secondary arterio-venous fistulae were included. Indications for therapy of the vascular malformation were based on patients’ symptoms and complications. The following endpoints were of clinical interest and were assessed: origin of development of arteriovenous fistula, development of secondary comorbidities as a result of the vascular malformation. For analysis we focused on descriptive statistics.

RESULTS: Out of 1213 consecutive patients with vascular malformations, in 6 patients perfusion changed from slow flow to arterio-venous fast-flow patterns. Four patients developed the fistula after local trauma in the area of the malformation, the other 2 patients developed the fistula due to progression of the disease and recurrent thrombophlebitis. These 2 patients had no trauma or interventions at the time of arterio-venous fistula development.

CONCLUSIONS: Acquired arterio-venous fast-flow fistula in patients with slow flow vascular malformation is very rare and might be a result of local trauma or the progression of the disease with recurrent thrombophlebitis. Specific evidence-based treatment options for these patients do not exist.

PMID:36565106 | DOI:10.3233/CH-221610

J Back Musculoskelet Rehabil. 2022 Dec 15. doi: 10.3233/BMR-220156. Online ahead of print.

ABSTRACT

BACKGROUND: For the treatment of single-level lumbar degenerative disc disease (DDD), oblique lateral interbody fusion (OLIF) has clinical advantages. Whether internal fixation needs to be combined for treatment has been the subject of debate.

OBJECTIVE: To compare the early clinical effects of standalone oblique lateral interbody fusion (S-OLIF) versus OLIF combined with lateral screw fixation of the vertebral body (F-OLIF) on single-level lumbar DDD.

METHODS: A retrospective analysis was performed on the data of 34 patients for whom the OLIF technique was applied to treat single-level lumbar DDD from August 2018 to May 2021. Patients were divided into the S-OLIF (n= 18) and F-OLIF groups (n= 16). Intraoperative blood loss, operative time, and length of hospital stay were recorded. The pain visual analogue scale (VAS) and Oswestry disability index (ODI) before and after the operation were evaluated. The disc height (DH), foraminal height (FH), fused segment lordosis (FSL), lumbar lordosis (LL), cage subsidence, and fusion by CT examination were measured before and after the operation.

RESULTS: The S-OLIF group experienced a shorter operative time and less intraoperative blood loss than the F-OLIF group, and the differences were statistically significant (p< 0.05), but the difference in the length of hospital stay was not statistically significant. The postoperative VAS score and ODI of the two groups were significantly lower than those before the operation, but the postoperative differences between the two groups were not statistically significant. Differences were not statistically significant in postoperative FH, DH, FSL and LL of the two groups. Both groups were followed up for no less than 12 months. In the two groups, fusion was achieved at the last follow-up visit.

CONCLUSION: According to short-term follow-up results, both S-OLIF and F-OLIF can achieve reliable and stable fusion and good clinical effect in the treatment of single-level lumbar DDD.

PMID:36565101 | DOI:10.3233/BMR-220156

Work. 2022 Dec 19. doi: 10.3233/WOR-211318. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses worldwide were exposed to increased levels of occupational stress during the COVID-19 pandemic which could have hindered their level of health-related quality of life (HRQoL).

OBJECTIVES: This project investigated HRQoL level in nurses during the COVID-19 pandemic and its health and occupational predictors.

METHODS: A cross-sectional design was adopted and targeted full-time nurses in Jordan. Study collected data included demographics, 12-item Short Form health survey (SF-12) to measure HRQoL, Nordic musculoskeletal questionnaire (NMQ), nurses’ evaluation of work conditions during COVID-19, and Depression Anxiety Stress Scale (DASS21). Data was analyzed descriptively to summarize main outcome measures and using multiple linear regression model to identify factors significantly associated with HRQoL.

RESULTS: In total 245 nurses successfully completed the survey, 39.6% were males with a mean age of 35±6 years. Participant SF12 scores were 65.94±17.85 for physical component and 50.09±19.36 mental component. The statistical model significantly explained 53.2% of variance in HRQoL (r2 = 0.534, F = 57.849, p < 0.001). Better sleep quality self-evaluation was significantly associated with higher HRQoL levels, while increased levels of depression, musculoskeletal pain, and financial burden on family were significantly associated with worse HRQoL level.

CONCLUSION: Jordanian nurses’ HRQoL level was relatively low during COVID-19. Sleep quality, mental health status, musculoskeletal health status, and financial status were identified as factors possibly influenced HRQoL among nurses during the COVID-19 pandemic. Nurses’ quality of life along with their mental and physical health should be considered by healthcare administrators in the remaining period of COVID-19 and in future similar emergencies.

PMID:36565084 | DOI:10.3233/WOR-211318

Nurs Open. 2022 Dec 24. doi: 10.1002/nop2.1529. Online ahead of print.

ABSTRACT

AIM: Post-embolization syndrome is a common adverse event following trans-arterial chemoembolization, which negatively impacts the daily life of the patients involved. This study examined whether perceptions around post-embolization syndrome and symptom interference among nurses affect their comfort care performance toward patients who have undergone this procedure.

DESIGN: A descriptive cross-sectional study.

METHODS: One hundred and fifty registered nurses were surveyed from September to November 2020. Perceived post-embolization syndrome, symptom interference, and comfort care (including physical, psychospiritual, sociocultural, and environmental dimensions) were measured. Data were analyzed using t-tests, analysis of variance, Pearson’s correlation, and a multivariate analysis of variance.

RESULTS: There were no individual effects found of perceived post-embolization syndrome or symptom interference on nurses’ comfort care performance. However, statistically significant interaction effects were found in terms of their sociocultural and environmental care.

CONCLUSION: Nurses who recognized both high post-embolization syndrome and symptom interference among their patients were found to provide greater sociocultural and environmental care. As such, nurses should improve their early symptom and symptom interference detection protocols based on current care guidelines and provide physical, psychospiritual, sociocultural, and environmental comfort care.

PMID:36565057 | DOI:10.1002/nop2.1529

Stat Med. 2022 Dec 24. doi: 10.1002/sim.9632. Online ahead of print.

ABSTRACT

Multivariate outcomes are common in pragmatic cluster randomized trials. While sample size calculation procedures for multivariate outcomes exist under parallel assignment, none have been developed for a stepped wedge design. In this article, we present computationally efficient power and sample size procedures for stepped wedge cluster randomized trials (SW-CRTs) with multivariate outcomes that differentiate the within-period and between-period intracluster correlation coefficients (ICCs). Under a multivariate linear mixed model, we derive the joint distribution of the intervention test statistics which can be used for determining power under different hypotheses and provide an example using the commonly utilized intersection-union test for co-primary outcomes. Simplifications under a common treatment effect and common ICCs across endpoints and an extension to closed-cohort designs are also provided. Finally, under the common ICC across endpoints assumption, we formally prove that the multivariate linear mixed model leads to a more efficient treatment effect estimator compared to the univariate linear mixed model, providing a rigorous justification on the use of the former with multivariate outcomes. We illustrate application of the proposed methods using data from an existing SW-CRT and present extensive simulations to validate the methods.

PMID:36565050 | DOI:10.1002/sim.9632